Tuesday Checkup

CLEVELAND, Ohio -- Back when physical labor was part of everyday life and more of us worked in labor-intensive jobs, being fat wasn't nearly as prevalent as it is now. Our sedentary jobs, it's often said, have had an impact on our waistlines.

That might be true, to an extent. But a recent study out of Massachusetts shows the equation is not that simple.

It seems that many low-wage workers who have nonsedentary jobs, from hotel housekeepers to construction laborers, are struggling with obesity.

The study, by the University of Massachusetts and the Massachusetts Coalition for Occupational Safety and Health (MassCOSH), was designed to investigate whether lower-income workers perceivedany factors in the workplace that affected their weight. Participants came from a variety of industries, including housekeeping/cleaning; construction; health care/human services; and manufacturing.

The participants described a range of factors influencing their diet, exercise and body weight -- notably, time pressure, psychological stress and decreased ability to exercise after injury or illness.

Marcy Goldstein-Gelb, executive director of MassCOSH, notes that the workers may be on their feet, "But it isn't the healthy type of physical activity. It's the kind that takes a toll on your body.

"The reason we became involved in this study is that we felt the voices of people in more labor-intensive jobs were not being heard when it came to health," she says. "All we see is that 'People are sedentary, they just need to take the stairs.' And I'd see people in the labor force and that wouldn't resonate with them.

"Something wasn't right."

What the study found, through interviews with eight focus groups (a total of 63 overweight or obeseworkers in the Greater Boston area) and supplemental interviews with 25 other low-wage workers, was that while their jobs required physical movement, they struggled with being overweight or obese.

Goldstein-Gelb says they described issues such as getting very short breaks during which to eat, having to eat while working, and not being near places that offered healthy meals -- or not having the time or money to afford them.

Sitting down and enjoying a salad was not an option as it may be for many office workers, she says.

"We saw situations like a housecleaner working till her body fell apart," Goldstein-Gelb says. "Many of them were injured through their work. Then they have to take medication that makes them gain weight, or they have limited mobility because of injuries and can't exercise."

They also faced psychological stress, which causes cortisol levels to increase, contributing to weight gain.

One worker described being struck by his supervisor. "He became so depressed, he could barely function," Goldstein-Gelb says. Low-wage workers sometimes face abuse, and tolerate it, because they desperately need the money, she adds.

While the group in the study was small, the findings bearout what Seeholzer observes at MetroHealth.

"I see a fair amount of patients in housekeeping roles, or who are shift workers and in health care, or who work in the food industry, and much of what they tell me is very similar to what this study shows," she says. "The study doesn't say, but many such workers tend to be single parents. When their jobs end, they come home, do laundry [and] keep house. Prepared and quick food are one of the only tools they have to save time."

Decades ago, when wives didn't work, they might have packed lunches for their husbands. Today, even when there are two parents, usually both work and few find the time to prepare lunch, Seeholzer says.

Workers often tell Seeholzer that they are pressured not to take the breaks they aresupposed to get. Many of them don't make a living wage at one job, so they have two, which means they work far more than 40 hours a week.

Workers who have to switch shifts, or who work night shifts, as nurses often do, see it take a toll on their body and weight. Studies have shown that working second or third shift can wreak havoc on hormone balances, and not getting enough sleep also causes cravings for simple carbs and sugar. Both can trigger weight-gain.

"Hormone imbalances and cortisol can increase appetite and reduce metabolic calorie burn," Seeholzer says. "Police officers, nurses -- these are people who work at night, and they are likely getting fast food."

In her book "Nickel and Dimed," author Barbara Ehrenreich worked a series of low-paying jobs, many similar to those described in the MassCOSH study.

She concluded, "All of these jobs were physically demanding, even damaging if performed month after month." But, as she said, she had the advantage of making herself a fit person over the years, working out at the gym and lifting weights, which helped her endure the work conditions.

Low-wage workers, Ehrenreich pointed out, do not have the advantages, time or wherewithal to do so.

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